Urgent Care: We've
Got It Down!"
by Christy K. Robinson
W hen one thinks of "urgent care" in a dental school setting,
a bad toothache comes to mind, or perhaps a broken tooth.
| The Life Savers | |
| Mary
Della Johnson, coordinator in Urgent Care/Screening office. Gloria Martinez, coordinator in Urgent Care/Screening office. Cindy Adell, RDA, CDA, Urgent Care/Screening dental assistant. Anthony Theodorou, SD'64, assistant professor of restorative dentistry. Miriam Yanez, record analyst in clinic administration, operator. Mary Hartwell, dental clinics manager. Larry Trapp, DDS, MS, attending, associate professor of anesthesiology. Franco Audia, SD'97, oral and maxillofacial surgery resident. Dr. Audia had completed his Advanced Cardiac Life Support training one day earlier. Rob Mower, SD'98, oral and maxillofacial surgery resident. David Toma, DMD, visiting resident from Johns Hopkins University. John Khalaf, SD'97, PG'99, dental anesthesiology resident. Fernando Muñoz, SD'97, PG'99, dental anesthesiology resident. Betty Jimenez, RDA, dental assistant in dental surgery center. Janine Frede, CDA, RDA, OSA, supervisor in oral surgery. Kelly Kallner, RDA, OSA, dental assistant in oral surgery. Many others, who assisted in crowd control, directed traffic, ran errands, etc. |
But when Robert Clement, DDS, director of the clinical services division of the School of Dentistry, collapsed in mid-sentence, he was in the best of all places for his cardiac arrest: in the Urgent Care department of the School of Dentistry.
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| Dr. Clement as commencement marshall, three days before his cardiac arrest. |
Dr. Clement had been on his way out of the office at nearly 4:30 on June 2, but had been called back by office staff Gloria Martinez and Mary Della Johnson. As Ms. Johnson conversed with Dr. Clement, she recalls that he just paused in mid-sentence, fell backwards against the wall and slid off the chair. Ms. Martinez dialed 8333, the dental school operator, for help; while Dr. Tony Theodorou loosened Dr. Clement's shirt and tie and started the assessment; and Ms. Johnson quickly cleared chairs and files in the way of help.
Miriam Yanez was the operator at the time. When the red emergency button
on her phone bank lit up, she dropped everything and followed a protocol
that includes calling the attending doctor and nurse on duty in the dental
surgery center, and dialing 911 for paramedic or ambulance assistance.
In addition, she notified Mary Hartwell, dental clinics manager, who set
another peripheral support team in motion. Ms. Yanez also calmly told
Mrs. Clement to come downstairs immediately.
"When you see someone you know, a professor, it's kind of shocking,"
says Dr. John Khalaf. "When the response team arrived, Dr. Clement
was already cyanotic or blue from lack of oxygen."
Drs. Khalaf, Muñoz, Audia,Toma, Mower, and Trapp checked Dr. Clement's
vital signs, and found him "pulseless and not breathing." They
began CPR.
Ms. Johnson and Ms. Martinez got "a look" that meant to move
Mrs. Clement out of sight because the team didn't want her to see her
husband's resuscitation. They took her around the corner and prayed with
her for the next few minutes. Mrs. Clement was repeating, "Come on,
Bob, you can do it."
Cindy Adell closed the rolling shutters of the office where all the activity
was, and started calming the patients and sending them home.
In the lobby and hallway of the Prince Hall, patients, faculty, students
and staff stood quietly, many of them praying.
"Dr. Trapp directed what to do, and assigned duties," said Dr.
Toma. "You manage the airway, you do compressions, you set up the
IV. Emergency equipment was summoned."
They put the EKG monitor on Dr. Clement and found he was in cardiac arrest.
The crew defibrillated Dr. Clement twice. He went from ventricular fibrillation,
a disorganized cardiac muscle contraction, into a slow but normal heart
rhythm, according to Dr. Trapp.
Dr. Audia started the first IV line and gave medications such as epinephrine
and lidocaine, and a team member documented times, procedures, and amounts
of drugs given.
Dr. Clement was intubated and ventilated. The paramedics arrived and transported
Dr. Clement to the Medical Center emergency room. When the emergency medical
technicians wheeled Dr. Clement's gurney out to the ambulance, they were
providing artificial respiration for him, according to one observer.
He was taken to Loma Linda University Medical Center. Dr. Trapp and Mrs.
Clement walked to the emergency room and a report was given to physicians.
Dr. Clement subsequently received a combination of pacemaker and implanted
cardioverter defibrillator (ICD). He was placed on a ventilator for a
short time.
Says Dr. Khalaf, "David Toma and I went and saw him a few days later,
and he was up and talking. It was a great feeling. It was a great experience."
Gloria Martinez remembers, "Mary Della and I agree that the angels
were watching over him. Dr. Clement tried twice to leave here that day,
but we needed to talk to him. He could have been going up the elevator
or out in the parking lot, and he could have been alone [when his heart
stopped]. He was where he needed to be. The response team was here. He
was here in the perfect place and time."
"The School of Dentistry, through their effort, saved Bob's life,"
says Mary Lou Clement. "It is a miracle and we walk among angels
here on earth. This all happened in the fashion it did, because of God's
will. It had to be God's hand."
"From the staff to the doctors, no one realizes how awesome this
team is!" says Janine Frede, oral surgery supervisor, who documented
procedures.
Dr. Muñoz, like every other lifesaver, downplayed his own role,
and emphasized that the team effort saved Dr. Clement's life. He says
that they did what they were trained to do.
Another staffer, commenting on the rapid, effective response of emergency
personnel, said, "We've got it down!"
"They deserve accolades for saving Bob's life," exults Mrs.
Clement. "They used the training they had received in an excellent
manner. I'm so appreciative of them saving Bob's life. It's a testament
to the quality of their training, the high quality of the postgraduate
program, the School, and the team. We owe them Bob's life. The Medical
Center cardiac staff said that the people at the School of Dentistry just
did everything right: they followed CPR protocol and handled an emotional
and traumatic situation with great expertise. They said that Dentistry
deserved a medal like a distinguished service award."
Mrs. Clement says that many School of Dentistry family have responded
overwhelmingly with prayers, visits, and support for Dr. Clement and herself.
"The prayers gave both of us strength."
Dr. Clement's cardiologist cleared him to return to work in the School
of Dentistry, so after a bit more rest, enforced by Mrs. Clement, he was
back.
Upon his return, the Urgent Care office staff presented Dr. Clement with
an Energizer Bunny, the kind that keeps going, and going, and going...
All contents copyright © 2001 Loma Linda University.
All rights reserved. Revised
February 28, 2001
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